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Mohit, Tomar MS, Sharma D, Nandan S, Pateriya A, Shrivastava A, Chand P. Emerging role of metabolomics for biomarker discovery in obstructive sleep apnea. Sleep Breath 2023; 27:1247-1254. [PMID: 36322226 DOI: 10.1007/s11325-022-02730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 03/12/2023]
Abstract
Obstructive sleep apnea (OSA) is characterized by the complete or partial blockage of the upper airway passage during sleep which causes repetitive breaks in sleep and may result in excessive daytime sleepiness. OSA has been linked to various metabolic disorders and chronic health conditions, such as obesity, diabetes, hypertension, and depression. Profiling of alterations in metabolites and their regulation in OSA has been hypothesized to be an effective approach for early diagnosis and prognosis of OSA. Several studies have characterized metabolic fingerprints associated with sleep disorders. There is a lack of understanding of metabolite contents and their alterations in OSA that may help to identify specific biomarkers. The information provided in this review will help update new methodologies and interventions of high throughput advanced molecular/metabolomics tools which may clarify the metabolic aspects and mechanisms for improved management and treatment of OSA.
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Affiliation(s)
- Mohit
- Department of Prosthodontics, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Manendra Singh Tomar
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Deepak Sharma
- Council of Scientific & Industrial Research, Phytochemistry Division, National Botanical Research Institute, Uttar Pradesh, Lucknow, 226001, India
| | - Shiv Nandan
- Department of Biotechnology, Era's Lucknow Medical College & Hospital, Uttar Pradesh, Lucknow, 226003, India
| | - Ankit Pateriya
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India
| | - Ashutosh Shrivastava
- Center for Advance Research, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India.
| | - Pooran Chand
- Department of Prosthodontics, King George's Medical University Lucknow, Uttar Pradesh, Lucknow, 226003, India.
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Wu W, Pu L, Hu X, Chen Q, Wang G, Wang Y. Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study. Front Neurosci 2023; 17:1161279. [PMID: 37325036 PMCID: PMC10266218 DOI: 10.3389/fnins.2023.1161279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Background Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. Objectives To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. Methods In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. Results In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Conclusion Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.
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Affiliation(s)
- Wenwen Wu
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihui Pu
- Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Brisbane, QL, Australia
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guan Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanyan Wang
- Science and Technology Department, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Molecular Pathology, Oxidative Stress, and Biomarkers in Obstructive Sleep Apnea. Int J Mol Sci 2023; 24:ijms24065478. [PMID: 36982552 PMCID: PMC10058074 DOI: 10.3390/ijms24065478] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is characterized by intermittent hypoxia (IH) during sleep due to recurrent upper airway obstruction. The derived oxidative stress (OS) leads to complications that do not only concern the sleep-wake rhythm but also systemic dysfunctions. The aim of this narrative literature review is to investigate molecular alterations, diagnostic markers, and potential medical therapies for OSAS. We analyzed the literature and synthesized the evidence collected. IH increases oxygen free radicals (ROS) and reduces antioxidant capacities. OS and metabolic alterations lead OSAS patients to undergo endothelial dysfunction, osteoporosis, systemic inflammation, increased cardiovascular risk, pulmonary remodeling, and neurological alterations. We treated molecular alterations known to date as useful for understanding the pathogenetic mechanisms and for their potential application as diagnostic markers. The most promising pharmacological therapies are those based on N-acetylcysteine (NAC), Vitamin C, Leptin, Dronabinol, or Atomoxetine + Oxybutynin, but all require further experimentation. CPAP remains the approved therapy capable of reversing most of the known molecular alterations; future drugs may be useful in treating the remaining dysfunctions.
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El-Solh AA, Rudraraju A, Pasrija D, Bui H. Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea. Expert Opin Pharmacother 2022; 23:507-516. [PMID: 35045769 DOI: 10.1080/14656566.2022.2029408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients with persistent sleepiness after adequate treatment of obstructive sleep apnea (OSA) with nasal continuous positive airway pressure (nCPAP) experience impaired cognition, reduced productivity, and worse quality of life. Although the mechanisms responsible for this phenomenon are not completely understood, neuroimaging studies have identified reduced gray matter in the frontal cortex and alterations in white matter integrity suggestive of axonal and myelin damage. The intermittent hypoxia with resulting oxidative injury is considered a prime culprit behind the loss of wake-promoting catecholaminergic neurons. AREAS COVERED This narrative review gives an overview of the pathophysiology and approaches to managing patients with residual sleepiness. The authors explore different targeted strategies aimed at improving selection of appropriate pharmacotherapy. EXPERT OPINION Wake-stimulant medications (modafinil and armodafinil) have demonstrated efficacy in reducing sleepiness in adequately treated OSA. The recent FDA approval of pitolisant and solriamfetol complements the use of modafinil by substituting for direct sympathomimetic agents. The distinctive pharmacologic profile and mode of action of each of these agents offer the opportunity of a personalized approach to the management of this disorder. Further studies should be conducted on the long-term effect of these agents alone or in combination on brain structural and functional changes.
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Affiliation(s)
- Ali A El-Solh
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Department of Epidemiology and Environmental Health; School of Public Health and Health Professions, University at Buffalo, USA
| | - Avantika Rudraraju
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Divij Pasrija
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Hoang Bui
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
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Conte L, Greco M, Toraldo DM, Arigliani M, Maffia M, De Benedetto M. A review of the "OMICS" for management of patients with obstructive sleep apnoea. ACTA ACUST UNITED AC 2021; 40:164-172. [PMID: 32773777 PMCID: PMC7416376 DOI: 10.14639/0392-100x-n0409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnaea (OSA) syndrome is a condition characterised by the presence of complete or partial collapse of the upper airways during sleep, resulting in fragmentation of sleep associated with rapid episodes of intermittent hypoxia (IH), activation of the sympathetic nervous system and oxidative stress. OSA is associated with a broad spectrum of cardiovascular, metabolic and neurocognitive comorbidities that appear to be particularly evident in obese patients, while affecting both sexes in a different manner and varying in severity according to gender and age. In recent years, studies on OSA have increased considerably, but in clinical practice, it is still a highly underdiagnosed disease. To date, the gold standard for the diagnosis of OSA is nocturnal polysomnography (PSG). However, since it is not well suited for a large number of patients, the Home Sleep Test (HST) is also an accepted diagnostic method. Currently, the major aim of research is to identify non-invasive methods to achieve a highly predictive, non-invasive screening system for these subjects. The most recent reports indicate that research in this field has made significant progress in identifying possible biomarkers in OSA, using -OMIC approaches, particularly in the fields of proteomics and metabolomics. In this review, we analyse these OMIC biomarkers found in the literature.
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Affiliation(s)
- Luana Conte
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Advanced Data Analysis for Medicine (ADAM), Department of Mathematics and Physics "E. De Giorgi", University of Salento, Lecce, Italy
| | - Marco Greco
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Domenico Maurizio Toraldo
- Department Rehabilitation "V. Fazzi" Hospital, Cardio-Respiratory Unit Care, ASL-Lecce, San Cesario di Lecce (LE), Italy
| | | | - Michele Maffia
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy.,Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-Lecce, Italy
| | - Michele De Benedetto
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy
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Lal C, Weaver TE, Bae CJ, Strohl KP. Excessive Daytime Sleepiness in Obstructive Sleep Apnea. Mechanisms and Clinical Management. Ann Am Thorac Soc 2021; 18:757-768. [PMID: 33621163 PMCID: PMC8086534 DOI: 10.1513/annalsats.202006-696fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Many patients with obstructive sleep apnea (OSA) experience excessive daytime sleepiness (EDS), which can negatively affect daily functioning, cognition, mood, and other aspects of well-being. Although EDS can be reduced with primary OSA treatment, such as continuous positive airway pressure (CPAP) therapy, a significant proportion of patients continue to experience EDS despite receiving optimized therapy for OSA. This article reviews the pathophysiology and clinical evaluation and management of EDS in patients with OSA. The mechanisms underlying EDS in CPAP-treated patients remain unclear. Experimental risk factors include chronic intermittent hypoxia and sleep fragmentation, which lead to oxidative injury and changes in neurons and brain circuit connectedness involving noradrenergic and dopaminergic neurotransmission in wake-promoting regions of the brain. In addition, neuroimaging studies have shown alterations in the brain's white matter and gray matter in patients with OSA and EDS. Clinical management of EDS begins with ruling out other potential causes of EDS and evaluating its severity. Tools to evaluate EDS include objective and self-reported assessments of sleepiness, as well as cognitive assessments. Patients who experience residual EDS despite primary OSA therapy may benefit from wake-promoting pharmacotherapy. Agents that inhibit reuptake of dopamine or of dopamine and norepinephrine (modafinil/armodafinil and solriamfetol, respectively) have demonstrated efficacy in reducing EDS and improving quality of life in patients with OSA. Additional research is needed on the effects of wake-promoting treatments on cognition in these patients and to identify individual or disorder-specific responses.
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Affiliation(s)
- Chitra Lal
- Medical University of South Carolina, Charleston, South Carolina
| | - Terri E. Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Charles J. Bae
- Penn Sleep Center, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Diallo I, Pak VM. Metabolomics, sleepiness, and sleep duration in sleep apnea. Sleep Breath 2020; 24:1327-1332. [PMID: 31955318 DOI: 10.1007/s11325-019-01969-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Although the mechanism is unclear, daytime sleepiness, a common sequela of obstructive sleep apnea (OSA), has been found to be correlated with a adverse cardiovascular outcomes. Reviewing metabolomics mechanisms of sleep disturbances and cardiovascular disease may help to explain this correlation. METHODS This review examines the current literature on the relationships between sleepiness, sleep duration, and metabolites in sleep apnea. RESULTS Although there is a lack of comprehensive literature in this emerging area, existing studies point to a variety of metabolites in different pathways that are associated with sleepiness and sleep duration. CONCLUSION Advancing metabolomics research in sleep apnea will guide symptom research and provide alternate and novel opportunities for effective treatment for patients with OSA.
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Affiliation(s)
- Idiatou Diallo
- Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victoria M Pak
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
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Koskinen A, Bachour A, Vaarno J, Koskinen H, Rantanen S, Bäck L, Klockars T. A detection dog for obstructive sleep apnea. Sleep Breath 2018; 23:281-285. [PMID: 29797188 DOI: 10.1007/s11325-018-1659-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/26/2018] [Accepted: 04/04/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE We sought to assess whether a dog can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the olfactory detection of urine. METHODS Urine samples were collected from 23 adult male obstructive sleep apnea patients and from 20 voluntary adult male volunteers. Three dogs were trained through reinforced operant conditioning. RESULTS Two of the three dogs correctly detected two thirds of obstructive sleep apnea patients (p < 0.000194 and p < 0.000003, respectively). CONCLUSIONS We found that dogs can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the smell of urine. Potentially, dogs could be utilized to identify novel biomarkers or possibly screen for obstructive sleep apnea.
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Affiliation(s)
- Anni Koskinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland
| | - Adel Bachour
- Sleep Unit, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jenni Vaarno
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland
| | - Heli Koskinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland
| | - Sari Rantanen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, PL 263, 00029, Helsinki, Finland.
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Mullington JM, Abbott SM, Carroll JE, Davis CJ, Dijk DJ, Dinges DF, Gehrman PR, Ginsburg GS, Gozal D, Haack M, Lim DC, Macrea M, Pack AI, Plante DT, Teske JA, Zee PC. Developing Biomarker Arrays Predicting Sleep and Circadian-Coupled Risks to Health. Sleep 2016; 39:727-36. [PMID: 26951388 DOI: 10.5665/sleep.5616] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience & Human Behavior, UCLA, Los Angeles, CA
| | - Christopher J Davis
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK
| | - David F Dinges
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Philip R Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC
| | | | - Monika Haack
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Diane C Lim
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Madalina Macrea
- Salem VAMC, Salem, VA.,University of Virginia, Charlottesville, VA
| | - Allan I Pack
- Department of Medicine, Center for Sleep and Circadian Neurobiology Translational Research Laboratories, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Xu H, Zheng X, Jia W, Yin S. Chromatography/Mass Spectrometry-Based Biomarkers in the Field of Obstructive Sleep Apnea. Medicine (Baltimore) 2015; 94:e1541. [PMID: 26448002 PMCID: PMC4616745 DOI: 10.1097/md.0000000000001541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biomarker assessment is based on quantifying several proteins and metabolites. Recent developments in proteomics and metabolomics have enabled detection of these small molecules in biological samples and exploration of the underlying disease mechanisms in obstructive sleep apnea (OSA). This systemic review was performed to identify biomarkers, which were only detected by chromatography and/or mass spectrometry (MS) and to discuss the role of these biomarkers in the field of OSA. We systemically reviewed relevant articles from PubMed and EMBASE referring to proteins and metabolite profiles of biological samples in patients with OSA. The analytical platforms in this review were focused on chromatography and/or MS. In total, 30 studies evaluating biomarkers in patients with OSA using chromatography and/or MS methods were included. Numerous proteins and metabolites, including lipid profiles, adrenergic/dopaminergic biomarkers and derivatives, amino acids, oxidative stress biomarkers, and other micromolecules were identified in patients with OSA. Applying chromatography and/or MS methods to detect biomarkers helps develop an understanding of OSA mechanisms. More proteomic and metabolomic studies are warranted to develop potential diagnostic and clinical monitoring methods for OSA.
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Affiliation(s)
- Huajun Xu
- From the Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China (HX, XZ, SY); and Center for Translational Medicine, and Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (HX, XZ, WJ)
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De Luca Canto G, Pachêco-Pereira C, Aydinoz S, Major PW, Flores-Mir C, Gozal D. Biomarkers associated with obstructive sleep apnea and morbidities: a scoping review. Sleep Med 2015; 16:347-57. [PMID: 25747333 DOI: 10.1016/j.sleep.2014.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/16/2014] [Accepted: 12/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To map potential biomarkers of obstructive sleep apnea (OSA)-associated morbidities in both adults and children, to identify gaps in current evidence, and to determine the value of conducting a full systematic review. METHODS A scoping review was undertaken of studies in patients with OSA that evaluated the potential value of biological markers in identifying OSA-associated morbidities. Retained articles were only those studies whose main objective was to identify morbidity biomarkers in subjects with OSA, the latter being confirmed with a full overnight polysomnography (PSG) in a laboratory or at-home settings. The methodology of the selected studies was classified using an adaptation of the evidence quality criteria recommended by the American Academy of Pediatrics. Additionally the biomarkers were categorized according to their potential clinical applicability. RESULTS 572 citations were identified of which 48 met inclusion criteria. Thirty-four studies were conducted in adults and 14 involved children. Most of the studies evaluated blood biomarkers, and presented 31 potential diagnostic biomarkers. CONCLUSION The majority of studies that performed explored blood-based biomarkers, with most not identifying definitive morbidity biomarkers. Of the potentially promising morbidity biomarkers, plasma IL-6 and high sensitivity C-reactive protein appear to exhibit a favorable profile, and may discriminate OSA patients with and without morbidities in both adults and children. MRP 8/14 was retained in children as well as cardiovascular morbidity-associated biomarker. Urinary neurotransmitters may also provide a good tool for screening OSA cognitive morbidity in children.
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Affiliation(s)
- Graziela De Luca Canto
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Camila Pachêco-Pereira
- School of Dentistry, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Secil Aydinoz
- GATA Haydarpasa Teaching Hospital, Istanbul, Turkey; Section of Pediatric Sleep Medicine, Department of Pediatrics, The University of Chicago, USA
| | - Paul W Major
- School of Dentistry, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, 5721 S. Maryland Avenue, MC 8000, Suite K-160, Chicago, IL 60637, USA.
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